Part of any successful implementation or upgrade is avoiding the traps that can put you behind schedule or over budget.

To help you avoid these potential set backs, we’ve developed a list of tips that we’ve found to be useful.  As we continue to perform 5010-related upgrade work for a number of clients, and thus come across more potential traps, we’ll update this list with new tips as we discover them.

Third-party Clearinghouses

When dealing with a third party clearing house, our main concern is not only testing the file format so that it is accepted on the clearinghouse site, but to also factor in testing time for when the file is sent from the clearinghouse to the actual payer. 

In the past we’ve run into some discrepancies regarding in-billing requirements based on the third party and what the actual payer is looking for.  We have been able to solve this problem by working with the clearinghouse to get supporting documentation from the payer, thus easing the edit on the clearinghouse side.  

Billing Provider Addresses

The Billing Provider Address you use on claims must be a physical address, as in version 5010 you can no longer use PO Box and lock box addresses as a billing provider address.  This rule applies to both professional and institutional claim formats.  A PO Box or lock box address can still be used as long as you report this location as a pay-to address location for payments and for correspondence from payers.   

The pay-to address is only needed if it is different than that of the billing provider.

Nine Digit Zip Codes

Providers must submit a full nine-digit ZIP code when reporting billing provider and service facility locations.  Updated four-digit extensions can be found on the U.S. Postal Service’s ZIP Code Lookup Tool, which can be accessed here.

EDI Patient Copy Testing

Did you know that Catch Data Systems has a utility that will copy live claims to your EDI 5010 test environment, eliminating the need for duel entry to get valid patient information and charges into your test UCI in order to get a test file created for a payer? 

To learn more about our EDI Patient Copy Testing Utility, and how it can save your staff’s time and allow them to focus their attention on more important tasks, contact us here.

We hope these tips help you and your team avoid the frustrating, but time consuming, “little things” that can often derail even the biggest projects.  For more assistance in identifying the possible changes that will need to be made within your dictionary structures, claim forms or dmbs screens, contact us here.